Summit Safety Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Previous JSA Review

• Has the previous JSA been reviewed?

  Yes

  No

  N/A

• Are there unresolved issues remaining?

  Yes

  No

  N/A

• What issues need to be resolved?

Site

• Has a JSA been completed?

  Yes

  No

  N/A

• Has everyone signed the JSA?

  Yes

  No

  N/A

• Is site clean and organized?

  Yes

  No

  N/A

• Are there unrecognized hazards present?

  Yes

  No

  N/A

• Are vehicles chocked and pointd toward the exit?

  Yes

  No

  N/A

• Are trenches and excavations protected?

  Yes

  No

  N/A

• Was One Call contacted?

  Yes

  No

  N/A

• Is LOTO being utilized?

  Yes

  No

  N/A

Hazardous Chemicals

• List of hazardous chemicals available?

  Yes

  No

  N/A

• Material Safety Data Sheets available?

  Yes

  No

  N/A

• Proper containers used with correct labeling?

  Yes

  No

  N/A

First Aid

• Is Eye Wash available?

  Yes

  No

  N/A

• Is First Aid Kit available and stocked?

  Yes

  No

  N/A

• Is at least one employee trained in First Aid / CPR on site?

  Yes

  No

  N/A

• Other observations

Vehicles

• Are fire extinguishers present, charged, and the correct size?

  Yes

  No

  N/A

• Is vehicle in good condition?

  Yes

  No

  N/A

• Is vehicle DOT compliant?

  Yes

  No

  N/A

• Is the vehicle clean inside?

  Yes

  No

  N/A

• Is the vehicle clean outside?

  Yes

  No

  N/A

• Is there damage to the vehicle?

  Yes

  No

  N/A

• Are the tires good?

  Yes

  No

  N/A

• Vehicle Unit Numbers

Personal Protective Equipment

• Are employees wearing correct eye protection?

  Yes

  No

  N/A

• Hard hats?

  Yes

  No

  N/A

• Steel toed boots?

  Yes

  No

  N/A

• Fire resistant clothing?

  Yes

  No

  N/A

• Hearing protection?

  Yes

  No

  N/A

• H2S Detector?

  Yes

  No

  N/A

• Fall Protection?

  Yes

  No

  N/A

• Is all PPE in good condition and clean?

  Yes

  No

  N/A

Mobile Equipment

• Is equipment damaged?

  Yes

  No

  N/A

• Cab clean and free of litter?

  Yes

  No

  N/A

• Seatbelts worn?

  Yes

  No

  N/A

• Being used correctly?

  Yes

  No

  N/A

• Does equipment require certification or specialized training?

  Yes

  No

  N/A

• Is operator qualified?

  Yes

  No

  N/A

• Are attachments in good working order?

  Yes

  No

  N/A

• Is equipment and attachments being utilized correctly?

  Yes

  No

  N/A

• Is equipment being serviced and maintained correctly?

  Yes

  No

  N/A

• Equipment Numbers

Tools

• Are tools in proper working order?

  Yes

  No

  N/A

• In good condition?

  Yes

  No

  N/A

• Are electrical cords in good shape?

  Yes

  No

  N/A

• Are accessories/attachments in good shape?

  Yes

  No

  N/A

• Are tools being utilized correctly?

  Yes

  No

  N/A

• Is proper tool being utilized?

  Yes

  No

  N/A

Trailers

• Is trailer being pulled by correct vehicle?

  Yes

  No

  N/A

• Has this vehicle been DOT'd?

  Yes

  No

  N/A

• Is trailer Annual Inspection up to date?

  Yes

  No

  N/A

• Is there damage to trailer?

  Yes

  No

  N/A

• Trailer Unit Numbers

Comments / Observations

• What follow up is required?

• Comments, Concerns, Reccomendations

Reviewed by:

• Site Supervisor

  Sign

• Safety Representative

  Sign